Hemodynamic Profiles During Pulmonary Artery Pressure Sensor Implantation: Risk Stratification in Chronic Heart...

Invasive hemodynamics may facilitate outpatient identification of ambulatory advanced heart failure. We analyzed cardiac failure risk stratified by four hemodynamic profiles recorded during implantation of the pulmonary artery pressure sensor, CardioMEMS heart failure system.

This multicenter, retrospective cohort study included patients with heart failure with reduced ejection fraction who underwent pulmonary artery pressure sensor implantation from 2015 to 2022. Hemodynamic profiles were categorized using the Stevenson heart failure classification, defining cold (impaired systemic perfusion) as a cardiac index of <2.2 L/min/m²; and wet (hemodynamic congestion) as a pulmonary capillary wedge pressure of ≥18 mm Hg. The primary end point was 1-year cardiac failure, including all-cause mortality, inotrope dependence, and the need for durable ventricular assist device or heart transplantation. Among 512 patients (median age 71 years, 28% female, 77% New York Heart Association functional class III, median N-terminal pro-B-type natriuretic peptide 2554 pg/mL), the hemodynamic profiles were as follows: 30% warm-dry, 22% warm-wet, 21% cold-dry, and 27% cold-wet. Overall, 118 patients (23%) experienced cardiac failure, of whom 57 required chronic inotrope, durable ventricular assist device implantation, or heart transplantation; 61 died despite medical therapy. The 1-year event-free survival rate differed across the profiles: warm-dry (90%), warm-wet (74%), cold-dry (80%), and cold-wet (61%) (P < 0.001). Multivariable analysis (reference: warm-dry) showed increased cardiac failure risk in cold-wet (adjusted hazard ratio [HR] 4.4, 95% confidence interval [CI] 2.4-7.8, P < 0.001), cold-dry (adjusted HR 2.2, 95% CI 1.1-4.2; P = 0.019), and warm-wet (adjusted HR 2.8, 95% CI 1.5-5.4; P = 0.001).

At the time of pulmonary artery pressure sensor placement, an abnormal hemodynamic profile-especially a cold-wet profile-was associated with increased cardiac failure risk, indicating subgroups who might have already progressed to ambulatory advanced heart failure.